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Study points to need to consider cervical cancer, even in cases where patient has had a pap smear

A London, Ont. study suggests cervical cancer may be getting prematurely dismissed as a possible diagnosis in cases where a patient had a recent pap smear test.

Lead researcher Dr. David D'Souza, a radiation oncologist with the London Regional Cancer Program, said many of the patients in the study group were shocked to find out they had cancer of the cervix because they'd followed recommendations for regular pap smear tests in women over 25.

The study looked at 38 women under the age of 50 treated at London Health Sciences Centre (LHSC) who had locally advanced cervical cancer that required chemotherapy. Of the 38 patients, 13 had undergone a pap smear in the two years prior to their diagnosis.

"Several of the patients said: 'How do I have this cancer when I had a pap test? My impetus was to ask why from the patient perspective.'"

D'Souza said the study shows that there remains a lot of misunderstanding about the link between symptoms and cancer of the cervix.

Dr. David D'Souza is a radiation oncologist with the London Regional Cancer Program. (LHSC)

Some women who took part in the study — published Wednesday in the medical journal Cureus — believe that delays in diagnosis reduced their quality of life and treatment outcomes.

"When their family doctor sees they have a normal pap test, there's a tendency to think 'Well, it can't be cervical cancer so let me think of everything else,'" said D'Souza.

The study was conducted by the Lawson Health Research Institute, the research institute of LHSC and St. Joseph's Health Care London.

D'Souza cautions the study isn't an indictment of the pap smear test as a screening tool. In fact, his study found the test has led to "a significant decline in cervical cancer incidence and mortality."

However, D'Souza said one takeaway is that the pap smear test "is not a perfect test by any means."

Symptoms dismissed

Ten of the women who took part in the study were interviewed about their treatment experience. Some reported being told that cervical cancer wasn't a likely diagnosis because of a recent pap test, among other factors.

One patient with symptoms typically associated with cervical cancer, such as pain and vaginal bleeding, was told she was "too young" to have cancer. In another case, a care team ruled out the possibility of cancer in a patient with vaginal bleeding because she'd had a recent pap test as part of her standard prenatal care.

Back pain and bleeding in another patient were dismissed because she had undergone a recent Cesarean section.

The study also found that in many cases, patients weren't given a detailed pelvic exam when symptoms suggested cancer as a possibility because they'd had a recent pap smear.

Some [patients] described feeling talked down to or not taken seriously.- Cervical cancer study

"Statements made during the interviews support that women were falsely reassured by a normal Pap smear and thought it was not possible they could have cervix cancer," the study says. "Some [patients] described feeling talked down to or not taken seriously."

The study concludes that caregivers need to consider cervical cancer as a possible diagnosis "irrespective of screening status.

It also points to "the importance of a pelvic exam as part of routine care and particularly when there are symptoms."

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